Download Case Study Oral and Parenteral Medication Administration, Skills & Reasoning (Latest 2025) and more Exams Nursing in PDF only on Docsity!
Case Study Oral and Parenteral Medication Administration, Skills &
Reasoning (Latest 202 5 )
Define Parenteral Administration administration of medication by injection into body tissue what type of procedure is parenteral administration? Invasive Procedure parenteral administration is an invasive procedure.
- what is the increased risk of this procedure, and what do we do to prevents that risk? A. increase risk of infection, B. use asepsis C. wear gloves what is the difference between onset of parenteral administration v.s non-parenteral medication? onset of medication is QUICKER via the parenteral route. what areas need to be avoided when administering medications via the parenteral route? avoid areas of trauma, skin alterations, & bony prominences. what are the 4 types of parenteral medication?
- Intramuscular (IM)
- Subcutaneous (SQ, SC)
- Intradermal (ID)
- Intravenous (IV)
what equipment can be used for parenteral medication? 1.Needles
- syringes
- vials
- ampules what are the parts of a needle? hub, shaft, and bevel how are needles packaged? Can be individually wrapped or pre attached to syringe the size of needle you choose depends on what factors?
- the location of injection
- type of injection (IM, ID, SC)
- size of patient
- viscosity (thickness) of medication how is the size of a needle measured?
- Based on gauge and length of needle --Ex. 21 G 1 inch; 25 G 5/8 inch; 10 G 1 ½ inch what is 'gauge'? Gauges (G): the diameter of needle; smaller number equals bigger needle ex. 31 G (smaller)- 19 (bigger)
what are general tips for injections?
- Use sharp needle (does that need to be stated )
- Use smallest needle that is adequate for medication and site
- *Insert quickly and smoothly
- Stabilize the skin and tissue that you are injecting
- Hold syringe stable while injecting medication Rotate sites if requiring multiple injections
- Don't massage injection sites ------It can cause bruising, tissue damage and affect absorption where do intramuscular injections deposit medication? into muscle tissue. how fast is IM absorbtion? Faster absorption versus subcutaneous injections secondary to vascular muscle tissue at what angle should you insert IM injection? insert at a 90 degree angle. what is the rule for amount administered via IM injections? Don't administer more than 3 ml per injection site what type of needle gauge and length should be used for IM injections?
- what factors effect the size you choose?
- Use 18-25 gauge needle and 5/8-1 ½ inches long
---Needle length depends on amount of subcutaneous tissue what method is recommended to reduce tissue irritation during IM injections? the Z-Track method what are the six steps to IM injections?
- cleanse area in circular motion
- hold syringe like a dart
- inject needle using a quick , smooth motion
- administer medication slowly
- withdraw needle
- apply gentle pressure what sites(body areas) do you preform IM injections?
- Ventrogluteal site
- Vastus Lateralis
- Deltoid Site what is the preferred and safest site for IM injections? Ventrogluteal site what muscle is being targeted when using the ventrogluteal site for IM injections? the gluteus medius muscle. when do you use the ventrogluteal site for IM injections? use for larger volumes (>2ml). what steps do you need to follow when administering IM injections to the ventrogluteal site? 1.position patient supine or lateral
when do you use the z-track method? For all intramuscular injections, use the Z-track method to prevent tissue irritation caused when medication leaks into subcutaneous tissues what is the purpose of the z-track method? Seals the medication in muscle tissue how do you perform the z-track method?
- Displace the skin and the subcutaneous tissue at the site about 1 to 1½ inches with the side of your nondominant hand
- Maintain this displacement throughout the injection and release it immediately after you withdraw the needle from the skin where do subcutaneous (SC or SQ) injections deposit medicine? into the the subcutaneous layer(fatty tissue) when do you use SQ injection method?
- used for injections of small volume (1 ml or less)
- used when slower absorption is required what angle to you administer SQ injections? angle of insertion is 45- 90 degrees. what size needle should be used for SQ injections Use a 25- to 30-gauge, ⅜- to ⅝-inch needle what are the preferred sites for SQ injections?
- outer posterior upper arm
- abdomen below costal regions of iliac crest and 2 inches from umbilicus what are other sites for SQ injections?
- anterior aspect of thighs
- scapular areas of upper back
- upper ventral or dorsal gluteal area what are the 7 steps to SQ injections? 1.cleanse area in circular motion 2.hold syringe like a pencil 3.pinch site while injecting 4.use swift, smooth motion while inserting needle 5.inject medication slowly 6.withdraw needle
- apply gentle pressure after removing needle where do intradermal (ID) injections deposit medicine? in the dermal layer of the skin. (right above the SQ layer) when do you use ID injections?
- typically used from skin testing, TB screening & Allergy test.
- for very small volume in injections
- used when medications are potent and are thus injected into the dermis where blood supply is reduced and medication absorption occurs slowly
- what angle so you insert needle for ID injections?
- what size needle should be used for ID injections?
- Insert at 5-15 degree angle
- 27-31gauge and ½ inch length (ex. tuberculin syringe)
Mixing compatible drugs avoids the need to give a patient more than one injection what is Insulin? Hormone used to treat diabetes (high risk medication) how can you classify insulin? *Classifications:
- Rapid acting (ex. Humalog)
- Short acting (ex. Regular)
- Intermediate acting (ex. NPH)
- Long acting (ex. Lantus) what to you need to know for determining when to administer insulin? When administrating you need to know the onset, peak, and duration of insulin how do you measure insulin? in Units. (usually 100 units in 1 mL) what is a serous risk factor to remember when administering insulin? Very small volumes and minimal errors in dosage can have a drastic effect for patients what form of parenteral medical administration needs to be used for insulin? typically administered via SQ injection. can insulin be administered IV? Only regular insulin can be given IV when very specific control of blood sugars is required
what are the characteristics of an insulin syringes? syringes hold 0.3 to 1 mL & have a pre-attached needle that cannot be removed when will different forms of insulin be mixed? to give better control of blood sugars what does the typical mixed insulin injection include? Typical insulin that are mixed are intermediate (NPH) and short acting (regular)
- Premixed insulin called 70/30 already has NPH (70%) and regular (30%) insulin mixed what is the rule of thumb when mixing insulin? GO FROM CLEAR TO CLOUDY what class of insulin should you never mix? LONG ACTING INSULIN.
- Lantus or levemire what are the six steps for mixing NPH and regular insulin? 1.Roll the vial of NPH insulin 2.Cleanse the top of both vials 3.Inject the correct amount of air into the NPH insulin first 4.Inject the correct amount of air into the into the regular insulin next 5.Withdraw the correct amount of regular insulin 6.Withdraw the correct amount of NPH insulin What forms are medications for oral administration available in? Tablets, capsules, and liquids. How are medications for oral administration typically administered? Usually by mouth (PO).
What is the three-step approach to dosage calculations?
- Determine the desired dose (in mg, g, mcg, or units). 2. Identify the quantity (in tablets or mL). 3. Calculate the amount to give based on the dose on hand. How do you calculate the dose when the drug order is allopurinol 200 mg and the available supply is 100 mg per tablet? You need to administer 2 tablets per dose. What should you do if the calculated dose seems unreasonable? Recheck your calculations, especially if the amount is less than ½ tablet or greater than 3 tablets. What are oral liquids used for in medication administration? They contain a specific amount of drug in a given amount of solution. How do you calculate the volume of an oral liquid that contains the prescribed dosage? Use the label to determine the amount of drug per mL or per multiple mL. What is the recommended measuring tool for doses less than 5 mL? Use oral syringes. What should be done when pouring liquid medications? Ensure the cup is at eye level and the liquid is at the lower level of the meniscus. What are the routes of administration for parenteral dosages? Intramuscular (IM), subcutaneous (SUBQ), intradermal (ID), and intravenous (IV). What are high-alert parenteral medications? Drugs that have a heightened risk of causing patient harm when used in error.
What is the most common unit for measuring insulin? U-100, which means 100 units per mL. What should you do when calculating dosages for injectable solutions? Round dosage calculations to the nearest 10ths for mL and to 100ths for less than 1 mL. What is the formula for calculating dosages? D x Q = Amount to give, where D is the desired dose and Q is the quantity. What should you look for when reading medication labels? Look for the smallest dosage available. What is the significance of accuracy in insulin administration? Errors can be life-threatening. What is the importance of estimating before applying any formula in dosage calculations? It helps to catch potential math errors before they affect the calculation. The subcutaneous route involves injection into _____ tissue. adipose What is the typical syringe size for a SQ injection? 1 - 2 mL What are medications that are typically given SQ? (5) heparin, lovenox, arixtra, insulin, neupogen What is arixtra? Neupogen?
What is the range of needle lengths for SQ injections? 3/8 to 5/8 inch How does the RN decide the needle length for a SQ injection? pinch the tissue and use half the width of the fold How does the RN decide what angle to insert the needle when giving a SQ injection? based off of how thick the fold of skin is when they pinch the tissue. for 1 inch, use a 45 degree angle. for 2 inches, use a 90 degree angle. We have an expert-written solution to this problem! Why do IM injections get absorbed more quickly? secondary to the increased blood flow to muscles than subcutaneous tissue What is the typical size syringe used for a IM injection? 1 - 3 mL What are four types of medications typically given IM? pain medications, antibiotics, vaccines, vitamins (commonly B12) What is the characteristic of sites typically chosen for IM injection? well-developed muscles The deltoid is the _____ muscle used for an IM injection, so therefore the _____ volume is used. smallest for both What is the preferred site of IM injection for infants-1.5 year olds? vastus lateralis
What is the preferred site for IMs (for anyone older than 1.5 years old)? Why? ventrogluteal. no major nerves, bones, or blood vessels What site poses the most risk for an IM? dorsogluteal What is the amount usually given in an IM? What happens if more than this is given? 2 - 3 mL. can cause abscesses or tracking. Two to three mL is the amount usually given via IM injection. What about to less developed muscles though? 1 - 2 mL Although it varies by age, site and the medication being administered, what is the usual needle gauge used for an IM injection? 21 - 23 The typical needle gauge used for an IM is 21-23. What about for peds? For the deltoid? For a viscous medication such as penicillin? 22 - 25. 23-25. 20. What is the typical needle length used for an IM? What about if it is to be given in the deltoid? To a pediatric patient? When might it have to be longer? 1 - 1.5 inches. 1 inch. 5/8-1 inch. for obese patients. How are intramuscular sites landmarked? using bones
anterior and lateral to the femur What are the two bony landmarks for the vastus lateralis site for IMs? greater trochanter, lateral knee Where do you inject an IM in the vastus lateralis site in relation to your two bony landmarks? inject in the middle third between the two points What age group is the vastus lateralis site traditionally used in? peds, choice for 1 year and younger because the other muscles are not well-developed yet What is a positive for the vastus lateralis site of IM injection? no major blood vessels How is the patient positioned for an IM injection in the vastus lateralis? supine with knees slightly flexed What are the two landmarks used for IMs given in the deltoid? acromion process and the midpoint of the lateral upper arm Where do you inject for an IM in the deltoid? 1 - 2 inches below the acromion process OR in the center of the imaginary upside down triangle What is one pro and one con for the deltoid as an IM site? con--injection into nerve or vessel. pro--rapid. An IM into the deltoid requires the use of a _____ needle. shorter
What are the two positions for an IM injection in the deltoid? seated with elbow flexed across the chest or standing with the arm hanging free Of the dorsogluteal, vastus lateralis and deltoid sites for IM injection, which is the fastest, the slowest and which is intermediate in rate of absorption? dorsogluteal is fastest, vastus lateralis is intermediate, deltoid is fastest Once you have found the site you are going to give an IM, how might you mark it? with the corner of an alcohol swab When preparing injectable medications, use _____ by washing your hands and keeping _____ and _____ sterile. asepsis, medications and supplies What components of a syringe are sterile? the needle, hub and plunger When is an independent check necessary prior to administering a medication? with high risk meds Why do you inject air into a vial prior to withdrawing medications? to create pressure with withdraw effectively How much air do you inject in a vial prior to withdrawing meds? same as the amount of medication you will be drawing out Withdraw medications from a vial _____ and keep needle below the _____ _____. slowly, fluid line
